Control-focused behavior therapy resulted with decrease in the severity of PTSD, depression and pain level: A case study

Control- Focused Behavior Therapy (CFBT) is a behavioral psychotherapy method that is proven to be an effective treatment of post-traumatic stress disorder with earthquake, torture, and war survivors. This case study aimed to test the effectiveness of CFBT on treating traumatic stress symptoms and chronic pain in a woman who had been exposed to physical partner violence. Ten sessions of CFBT treatment including two control interviews- one six weeks, and one a year laterwere applied. Taking the patient’s pain complaints into account, the level of pain was also monitored. The treatment resulted in a decrease in the levels of PTSD and depression symptoms, pain severity, and an increase in functioning. This improvement was maintained at a 1-year follow-up. The results of this study suggest that CFBT can be used as an effective treatment method for victims of partner violence, but it is necessary to prove this effect with studies with control groups to be carried out with this sample. Additionally, treating PTSD symptoms among chronic pain patients could help them to overcome severe pain without drug use.

Kontrol odaklı davranış terapisi, TSSB şiddetinde, depresyonda ve ağrı düzeyinde azalma ile sonuçlandı: Bir vaka çalışması

Kontrol Odaklı Davranış Terapisi (KODT), deprem, işkence ve savaş mağdurları ile yapılan çalışmalarda travma sonrası stres bozukluğunun (TSSB) tedavisinde etkili bir yöntem olduğu kanıtlanmış davranışsal bir psikoterapi yöntemidir. Bu vaka çalışması, fiziksel partner şiddetine maruz kalan bir kadında KODT'nin travmatik stres semptomları ve kronik ağrı tedavisinde etkinliğini test etmeyi amaçlamaktadır. Danışana biri 6 hafta, diğeri bir yıl sonra olmak üzere iki kontrol görüşmesini de içeren 10 seanslık KODT uygulanmıştır. Danışanın kronik ağrı yakınmaları olduğu için ağrı düzeyi de takip edilmiştir. Müdahale, travma sonrası stres bozukluğu ve depresyon belirti düzeyinde ve ağrı şiddetinde azalma ve işlevsellikte artış ile sonuçlanmıştır. İyileşmenin 1 yıllık takipte de devam ettiği görülmüştür. Bu çalışmanın sonuçları, KODT'nin şiddete maruz kalanlar için de etkili bir müdahale yöntemi olarak kullanılabileceğini; bu örneklemle gerçekleştirilecek kontrol gruplu çalışmalar ile bu etkinin kanıtlanmasının gerekli olduğunu göstermiştir. Ayrıca, kronik ağrı hastalarında TSSB belirtilerini tedavi etmek, ilaç kullanmadan şiddetli ağrının üstesinden gelmelerine yardımcı olabilir.

PDF

___

Aker, A. T., Özeren, M., Başoğlu, M., Kaptanoğlu, C., Erol, A., & Buran, B. (1999). Klinisyen tarafından uygulanan Travma Sonrası Stres Bozukluğu Ölçeği (TSSB-Ö)- geçerlik ve güvenilirlik çalışması. Türk Psikiyatri Dergisi, 10(4), 286-293.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorder. (5th ed.). American Psychiatric Publishing.

Asmundson, G. J. G., Coons, M. J., Taylor, S., & Katz, J. (2002). PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. The Canadian Journal of Psychiatry, 47, 930-937.

Başoğlu, M., & Mineka, S. (1992). The role of uncontrollable and unpredictable stress in posttraumatic stress responses in torture survivors. In M.

Başoğlu (Ed.), Torture and its consequences: Current treatment approaches (p. 182–225). Cambridge University Press.

Başoǧlu, M., & Şalcıoğlu, E. (2011). A mental healthcare model for mass trauma survivors: Control-focused behavioral treatment of earthquake, war, and torture trauma. Cambridge University Press.

Başoğlu, M., Livanou, M., & Şalcıoğlu, E. (2003a). A single session with an earthquake simulator for traumatic stress in earthquake survivors. American Journal of Psychiatry, 160(4), 788-790.

Başoǧlu, M., Livanou, M., Şalcıoğlu, E., & Kalender, D. (2003b). A brief behavioral treatment of chronic posttraumatic stress disorder in earthquake survivors: Results from an open clinical trial. Psychological Medicine, 33, 647-654.

Başoğlu, M., Marks, I. M., Kılıç, C., Brewin, C. R., & Swinson, R. P. (1994). Alprazolam and exposure for panic disorder with agoraphobia: Attribution of improvement to medication predicts subsequent relapse. British Journal of Psychiatry, 164, 652-659.

Başoǧlu, M., Şalcıoğlu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waiting list-controlled trial. Journal of Traumatic Stress, 18, 1-11.

Başoğlu, M., Şalcıoğlu, E., Livanou, M., Özeren, M., Aker, T., Kılıç, C., & Mestçioğlu, Ö. (2001). A study of the validity of a screening instrument for traumatic stress in earthquake survivors in Turkey. Journal of Traumatic Stress, 14, 491-509.

Beck, J. G., & Clapp, J. D. (2011). A different kind of comorbidity: Understanding posttraumatic stress disorder and chronic pain. Psychological Trauma: Theory, Research, Practice, and Policy, 3(2), 101-108.

Bennett, R.M., Friend, R., Jones, K.D., Ward, R., Han, B.K., & Ross, R.L. (2009). The revised fibromyalgia impact questionnaire (FIQR): Validation and psychometric properties. Arthritis Research & Therapy, 11(4), 120-132.

Berger, R. (2015). Stress, trauma, and posttraumatic growth: Social context, environment, and identities. Routledge.

Butchart, A., & Mikton, C. (2014). Global status report on violence prevention, 2014. https://uwe-repository.work tribe.com/output/823501/global-status-report-onviolence-prevention-2014

Cankardaş S., & Sofuoğlu, Z. (2019). Post-traumatic stress disorder symptoms and their predictors in earthquake or fire survivors. Turkish Journal of Psychiatry, 30(3), 151-156.

Cankardaş-Nalbantçılar, S. (2018). The relationship between psychological intimate partner violence and PTSD: The mediating role of peri-traumatic distress, peri-traumatic sense of control, and post-trauma emotions. (Unpublished Doctoral Dissertation). Istanbul Arel University, Istanbul, Turkey.

Cohen, H., Neumann, L., Haiman, Y., Matar, M.A., Press, J., & Buskila, D. (2002). Prevalence of post-traumatic stress disorder in fibromyalgia patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome? Semin Arthritis Rheum, 32, 38-50.

Cowen, R., Stasiowska, M.K., Laycock, H., & Bantel, C. (2015). Assessing pain objectively: The use of physiological markers. Anaesthesia, 70(7), 828-847.

Dutton, M.A., Green, B.L., Kaltman, S.I., Roesch, D.M., Zeffiro, T.A., & Krause, E.D. (2006). Intimate partner violence, ptsd, and adverse health outcomes. Journal of Interpersonal Violence, 21(7), 955-968.

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences (Therapist Guide). Oxford University Press.

Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alvarez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms?. Journal of Consulting and Clinical Psychology, 70(4), 1022.

Kakuma, R., Minas, H., Van Ginneken, N., Dal Poz, M.R., Desiraju, K., Morris, J.E., Saxena, S., & Scheffler, R.M. (2011). Human resources for mental health care: Current situation and strategies for action. Global Mental Health, 378(9803), 1654-1663.

Knoerl, R., Lavoie Smith, E.M., & Weisberg, J. (2016). Chronic pain and cognitive behavioral therapy: An integrative review. Western Journal of Nursing Research, 38(5), 596- 628.

Larsen, S. E., Stirman, S. W., Smith, B. N., & Resick, P. A. (2016). Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behaviour Research and Therapy, 77, 68-77.

Marks, I.M. (2002). The maturing of therapy: Some brief psychotherapies help anxiety/ depressive disorders, but mechanisms of action are unclear. The British Journal of Psychiatry, 180, 200-204.

McBeth, J., Silman, A.J., Gupta, A., Chiu, Y.H., Ray, D., Morriss, R., Dickens, C., King, Y., & Macfarlane, G.J. (2007). Moderation of psychosocial risk factors through dysfunction of the hypothalamic- pituitaryadrenal stress axis in the onset of chronic widespread musculoskeletal pain: Findings of a population‐ based prospective cohort study. Arthritis & Rheumatism, 56(1), 360-371.

Marks, I. M., Lovell, K., Noshirvani, H., & Livanou, M. (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55, 317 -325.

McFarlane, A.C., Atchison, M., Rafalowicz, E., & Papay, P. (1994). Physical symptoms in post -traumatic stress disorder. Journal of Psychosomatic Research, 38, 715 - 726.

Nicol, A.L., Sieberg, C.B., Cauw, D.J., Hassett, A.L., Moser, S.E., & Brummett, C.M. (2016). The association between a history of lifetime traumatic events and pain severity, physical function, and affective distress in patient with chronic pain. Pain, 17(12), 1334 -1348.

Norcross, J.C., Krebs, P.M., & Prochaska, J.O. (2011). Stages of change. Journal of Clinical Psychology, 67(2), 143 -154.

Şalcıoğlu, E., Başoğlu, M., & Livanou, M. (2007). Effects of live exposure on symptoms of posttraumatic stress disorder: The role of reduced behavioral avoidance in improvement. Behaviour Research and Therapy, 45(10), 2268 -2279.

Şalcıoğlu, E., Urhan, S., Pirinccioglu, T., & Aydin, S. (2017). Anticipatory fear and helplessness predict ptsd and depression in domestic violence survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 117 -125.

Sharp, T.J., & Harvey, A.G. (2001). Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clinical Psychology Review, 21, 857 -877.

Wald, J., Taylor, S., Chiri, L. R., & Sica, C. (2010). Posttraumatic stress disorder and chronic pain arising from motor vehicle accidents: Efficacy of interoceptive exposure plus trauma- related exposure therapy. Cognitive Behaviour Therapy, 39(2), 104 -113.

Yehuda, R. (2000). Biology of posttraumatic stress disorder. The Journal of Clinical Psychiatry, 61(suppl 7), 14- 21.